Parathyroidectomy Improves Blood Pressure Control: A Longitudinal Study of Patients on Maintenance Hemodialysis with Secondary Hyperparathyroidism

摘要

BACKGROUND. Secondary hyperparathyroidism (SHPT) and its associated complications, such as hypertension, are common sequelae of end stage kidney disease (ESKD). We aimed to evaluate the post-parathyroidectomy (PTX) effects on blood pressure (BP) (including predialysis and intradialytic BP), as well as determine the predictive factors involved in BP reduction post PTX.METHODS. Between 2002 and 2007, 17 hemodialysis patients who underwent PTX for SHPT were evaluated. Laboratory values, dry body weight (DBW) and predialysis and intradialytic BP at 6 months and 1 month prior to surgery as well as 1, 6 and 12 months postoperatively were evaluated. Factors affecting the decline in BP were also studied.RESULTS. The serum levels of calcium, serum phosphorus and intact parathyroid hormone significantly decreased following PTX and remained decreased up until 12 months postoperatively. There was no significant difference in predialysis and intradialytic BP in the 6 months prior to surgery. Compared to both systolic BP (SBP) and diastolic BP (DBP) (151.8 (+-) 22.7 mmHg and 80.7 (+-) 9.0 mmHg) at 1 month prior to PTX, predialysis BP decreased significantly at 6 months postoperatively (125.8 (+-) 19.0 mmHg; P < 0.001 and 73.3 + 8.0 mmHg; P = 0.004), and remained decreased up until 12 months postoperatively (125.2 (+-) 19.0 mmHg; P < 0.001 and 73.3 + 6.8 mmHg; P = 0.006). Similar results were found for intradialytic BP. DBW (55.9 (+-) 8.9 kg) decreased significantly (P = 0.011) following PTX but increased over time and showed a significant difference at 12 months postoperatively (57.3 (+-) 8.5 kg; P = 0.007). In addition, predialysis diastolic BP was the only predictor of the hypotensive effect of PTX.CONCLUSION. A decline in BP, including predialysis and intradialytic BP, was noted in hemodialysis patients with SHPT after PTX. Therefore, intensified BP control could be achieved by PTX to prevent complicating hypertension.